Healthcare Provider Details

I. General information

NPI: 1083075352
Provider Name (Legal Business Name): ELITE PAIN SPECIALISTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13141 SPRING HILL DR
SPRING HILL FL
34609-5016
US

IV. Provider business mailing address

PO BOX 20494
TAMPA FL
33622-0494
US

V. Phone/Fax

Practice location:
  • Phone: 352-515-0025
  • Fax: 813-406-4691
Mailing address:
  • Phone: 352-515-0025
  • Fax: 352-515-0174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License NumberME123669
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY ISENALUMHE JR.
Title or Position: OWNER
Credential: MD
Phone: 352-515-0025